Sops Check List by PHC (Wards) : Name of Focal Person & Signature: Contact#

SOPs Check list by PHC (Wards) Date: ______to ________

Ward Name: Name of Head Nurse & Signature: Contact #:

Name of Focal Person & Signature: Contact#:

Note: Data should be from 1st -14th and 15th to 28th of every month and should reach office of Dr. Farhana Naeem (Labor Room) on 16th & 1st of every month positively.
Serial # Indicator Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total
Date
1. Total cases
admitted
2. Number of
cases in
which nursing
plan is
documented
3. Plan &
outcome
documented &
signed by
Consultant
4. Plan &
outcome
either not
documented
or not signed
by Consultant
5. Total cases
needing
nutritional
assessment
6. Number of
cases
nutritional
assessment
performed
Monitoring Use of Blood and Blood Products
Date
7. Total
transfusions
8. Total reactions
9. Number of
Major
transfusion
reactions
reported
10. Number of
minor
transfusion
reactions
reported
11. Number of
blood or blood
products
wasted due to
transfusion
reactions
12. Number of
blood
components
used
13. Number of
whole blood
transfusions
14. Turnaround
time for blood
components
15. Turnaround
time for whole
blood
Monitoring of Invasive Procedures
Date
16. Total procedures

performed
17. Number of
unplanned
procedures
(Emergency)
18. Number of
unplanned
procedures
(Elective)
19. Number of Cases
in which
prevention
protocol of
adverse event
followed
20. Total number of
cases requiring
prophylactic
antibiotics
21. Number of cases
in which antibiotic
given within
specified time
22. Total no of cases
in consent for
Examination was
taken
in consent for
Admission was
taken
in consent for
Operation/Invasive
procedure was
taken
in consent for
anesthesia was
taken
Monitoring of Adverse Drug Events
Date
26. Total admissions in

ward
27. Number of cases in

which medication
errors
reported/identified
28. Number of adverse
reactions reported
29. Number of charts in

which abbreviations
used
30. Number of charts

with standard
abbreviations
31. Number of charts in

which non-standard
or error prone
abbreviations used
32. Total number of
treatment charts
reviewed
33. Total number of

patients who
received high risk
medications
34. Number of patients
who developed
adverse reaction or
given without
prescription or
wrong medicine
used
Monitoring of Use of Anesthesia
Date
35. Number of cases

undergoing Surgical
operations
requiring anesthesia
37. Type of
anesthesia
(General)
38. Type of
anesthesia
(Spinal/Local)
39. Number of cases
in which plan
modified
(Spinal/Local)
40. Number of cases
in which
unplanned
ventilation
required (General)
41. Number of cases
in which
unplanned
ventilation
required
(Spinal/Local)
42. Number of cases
in which adverse
events
reported/docume
nted (General)
43. Number of cases
in which adverse
events
reported/docume
nted (Spinal/Local)
44. Anesthesia
related deaths
recorded (General)
45. Anesthesia
related deaths
recorded
(Spinal/Local)
Date
46. No of cases in which

informed consent for
Anesthesia taken
47. No of cases with pre

-anesthesia
evaluation & plan
documented
immediate pre-
operative
assessment was
documented
intra-operative
assessment was
documented
post-operative
recovery assessment
was documented
CHECKLIST FOR ANESTHESIA Date:_____ to_______
Name & designation of concerned officer: Signature: Contact#:
Note: Data should be from 1st -14th and 15th to 28th of every month and should reach office of Dr. Farhana Naeem (Labor Room) on 16 th & 1st of every month positively.
Indicator
S Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total
Serial #
Date
51. Number of cases

undergoing Surgical
operations
requiring anesthesia
53. Type of anesthesia
(General)
54. Type of anesthesia

(Spinal/Local)
which plan
modified(general)
which plan modified
(Spinal/Local)
which unplanned
ventilation required
(General)
which unplanned
ventilation required
(Spinal/Local)
Indicator
S Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total
Serial #
Date

which adverse
events
reported/documente
d (General)
which adverse
events
reported/documente
d (Spinal/Local)
61. Anesthesia related
deaths recorded
(General)
62. Anesthesia related
deaths recorded
(Spinal/Local)
informed consent for
Anesthesia taken
64. No of cases with pre
-anesthesia
evaluation & plan
documented
immediate pre-
operative
assessment was
documented
intra-operative
assessment was
documented
post-operative
recovery assessment
was documented
SOPs Check list by PHC (Radiology & Lab) Date: ______to _______
Name & designation of concerned officer: Contact #: Signature:
Monitoring of Diagnosis Services

Date
Number of
1.
reporting
errors/1000
investigations
Total
2.
investigations
performed
Number of
3.
investigations
needing revision
or re-dos
Laboratory
X-Rays
C.T Scan
USG
Total number of
4.
employees
working in
diagnostics
Workers who
5.
follow all safety
precautions
SOPs Check list by PHC (Blood Bank) Date: ______to _______
Monitoring Use of Blood and Blood Products

Date
Total transfusions
6.
Total reactions
7.
Number of Major
8.
transfusion
reactions reported
Number of minor
9.
transfusion
reactions reported
Number of blood
10.
or blood products
wasted due to
transfusion
reactions
Total wastage
11.
Waste due to
12.
expiry of shelf life
Waste due to
13.
storage problems
Number of blood
14.
components used
Number of whole
15.
blood transfusions
Turnaround time
16.
for blood
components
Turnaround time
17.
for whole blood
SOPs Check list by PHC (Pharmacy) Date: ______to _______
Monitoring of Adverse Drug Events

Date
18. Total admissions in

Hospital
Number of cases in
19.
which medication
errors
reported/identified
Number of drugs
20.
dispensed from
hospital pharmacy
Number of adverse
21.
reactions reported
Number of charts
22.
in which
abbreviations used
Number of charts
23.
with standard
abbreviations
Number of charts
24.
in which non-
standard or error
prone
abbreviations used
Total number of
25.
treatment charts
reviewed
Total number of
26.
patients who
received high risk
medications
Number of patients
27.
who developed
adverse reaction or
given without
prescription or
wrong medicine
used

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SOPs Check list by PHC (Wards) Date: ______to ________

Ward Name: Name of Head Nurse & Signature: Contact #:

Name of Focal Person & Signature: Contact#:

16. Total procedures

26. Total admissions in

27. Number of cases in

29. Number of charts in

30. Number of charts

31. Number of charts in

33. Total number of

35. Number of cases

46. No of cases in which

47. No of cases with pre

Name & designation of concerned officer: Signature: Contact#:

51. Number of cases

54. Type of anesthesia

59. Number of cases in

Name & designation of concerned officer: Contact #: Signature:

Monitoring of Diagnosis Services

Name & designation of concerned officer: Contact #: Signature:

Monitoring Use of Blood and Blood Products

Name & designation of concerned officer: Contact #: Signature:

Monitoring of Adverse Drug Events

18. Total admissions in

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